Provider Demographics
NPI:1336949031
Name:CORNETT, TARA MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:CORNETT
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1547 ISLAND BREEZE PT
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4841
Mailing Address - Country:US
Mailing Address - Phone:904-338-7287
Mailing Address - Fax:
Practice Address - Street 1:580 WEST 8TH STREET
Practice Address - Street 2:TOWER 1 /SUITE 505
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209
Practice Address - Country:US
Practice Address - Phone:904-244-9571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9363891363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health